ARTICLE
Success of Rigid Gas Permeable Contact Lens Fitting
Sara Ortiz-Toquero, M.Sc., Mario Martin, O.D., Guadalupe Rodriguez,
and Raul Martin, Ph.D.
Objectives: To assess the percentage of successful rigid gas permeable
(GP) contact lenses (CLs) fit for both refractive and therapeutic reasons.
Methods: New CLs (soft or GP) fittings were retrospectively analyzed and
divided into refractive and therapeutic prescriptions. A standardized fitting
protocol that included complete CLs information after a first eye
examination, a diagnostic fitting visit, a dispensing visit, and a prescribing
visit was used in all fittings. A GP fitting was defined as successful if full-
time wear and optimal ocular surface physiology were both achieved at the
review assessment 2 to 3 weeks after lens dispensing.
Results: Of 232 new CLs fittings analyzed, 166 were refractive fittings
(71.6%) and 66 were therapeutic (28.4%). Of the refractive fittings, 88
subjects (53%) were initially fitted with GP CLs and 61 (69.3%) of these
met the criteria for successful GP fitting. Within this group, a different
percentage of successful fits were found for neophyte (72%), previous soft
lens wearers (62%), and previous GP wearers (92.3%). Of the therapeutic
fittings, 61 subjects (92.4%) were initially fitted with GP CLs and 59
(96.7%) of these met the criteria for successful GP fitting.
Conclusions: Following a standardized CLs fitting protocol, a relatively
high percentage of successful GP fits was achieved for refractive (7/10
subjects) and therapeutic (9/10 subjects) prescriptions. These results will
improve the information available to patients and aid in their CL choices by
providing them with a realistic attitude. It will also help eye care
practitioners in their clinical activities by providing evidence-based
information.
Key Words: Gas permeable—Contact lenses—Success—Fitting.
(Eye & Contact Lens 2016;0: 1–6)
R igid contact lenses (CLs) have been used to correct refractive
errors since 1888. The lenses were initially designed as large
diameter scleral lenses that used oxygen-impermeable materials
(glass and later, polymethylmethacrylate). Close to a century later,
in the 1970s, small diameter corneal lenses with gas permeable (GP)
From the Departamento de Física Teórica (S.O.-T., G.R., V.d.J., R.M.),
Atómica y Óptica, Universidad de Valladolid, Valladolid, España; Universi-
dad de Valladolid (S.O.-T., G.R., V.d.J., R.M.), Instituto Universitario de
Oftalmobiología Aplicada (IOBA), Valladolid, España; and Optometry
Research Group (S.O.-T., M.M., G.R., V.d.J., R.M.), IOBA Eye Institute,
School of Optometry, University of Valladolid, Valladolid, Spain.
S. Ortiz-Toquero was supported by Junta Castilla y León (Consejeria de
Educación), Program: Estrategia Regional de Investigación Científica, De-
sarrollo Tecnológico e Innovación 2007 to 2013, co-funding by Social
European Fund. The remaining authors have no funding or conflicts of
interest to disclose.
Address correspondence to Raul Martin, Ph.D., IOBA Eye Institute,
University of Valladolid, Paseo de Belen, 17, 47011 Valladolid, Spain;
e-mail: raul@ioba.med.uva.es
Accepted January 4, 2016.
DOI: 10.1097/ICL.0000000000000254
Eye & Contact Lens
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M.Sc., Victoria de Juan, Ph.D.,
materials1 were introduced. These provided rigid GP lenses that
improved patient tolerance and reduced CL-related complications.2
Later advances in manufacturing technology permitted the devel-
opment of high oxygen permeability materials that were approved
for continuous GP wear.
At present, more than 125 million people are estimated to wear
CLs worldwide.1 The GP fitting rate around the world has been
reported to be less than 11% over the past decade.1,3 Nevertheless,
GP lenses present major advantages over soft lenses, such as
greater tolerance in patients with dry eye or giant papillary con-
junctivitis, in addition to more tear turnover, which provides a bet-
ter physiological interaction between the lens and the ocular
surface, and high oxygen transmissibility.4–6 The lenses generally
provide patients with excellent vision and more effectively correct
high astigmatism.4,5
Gas permeable lens wearers experience a lower number of CL-
related complications than soft CLs wearers, and they have a lower
incidence of serious complications such as microbial keratitis.7 The
proportion of GP CLs fittings is clearly low compared with soft
lens prescriptions. The low prescription rate for GP lenses suggests
that these lenses are not the first choice option when fitting CLs for
refractive reasons in healthy eyes (e.g., for myopia, hyperopia, and
regular astigmatism correction).3 It has been suggested that a clini-
cian’s goal should be “to prescribe a CL from a physiologically
adequate material that will have minimal mechanical impact on the
corneal surface while providing the required optical correction.”8 If
practitioners followed this recommendation, a large number of GP
lens prescriptions would be expected, but GP lenses represent less
than 11% of the patients who wear this type of lens, demonstrating
a poor acceptance by practitioners and a substantial failure of pa-
tients to accept this type of lenses, which may be related to initial
discomfort or other problems adapting to the lens.4,9,10 Several
factors can influence a GP CLs fitting, including initial discomfort
with the lenses and the additional time required to successfully fit
and manage a patient, particularly for novice practitioners. Addi-
tionally, large investments on promoting and developing new soft
lens designs and materials9,10 likely affect practitioner’s recommen-
dations toward soft lenses.
However, many eye care practitioners propose GP CLs in
specialty cases and for challenging patients, such as those with
keratoconus or pellucid marginal degeneration, for corneal distor-
tion or irregularity after refractive surgery, or in orthokeratology
treatments,1,3,11 especially for the control of myopia.12
The aim of this study was, therefore, to assess the percentage of
successful GP CLs fits in healthy subjects (refractive prescriptions
fitted for only refractive reasons) and in special subjects (fitted with
a therapeutic objective) to provide evidence for the current
percentage of successful GP lens fits, to aid eye care practitioners
1
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in their CL clinical activities, and to improve the information

available to patients to help them to select the most adequate lens
for their case.

MATERIALS AND METHODS

A retrospective analysis was conducted that included new
subjects who were evaluated for the first time and fitted with any
type of CL at the Optometry Group of the IOBA Eye Institute
(University of Valladolid, Spain), which is a tertiary referral clinic
that treats patients with irregular corneas and other eye disorders,
during the period from January 2010 through December 2014. The
study was approved by the Human Sciences Ethics Committee of
the University of Valladolid. Informed consent was obtained from
each subject, and all subjects were treated in accordance with the
Declaration of Helsinki.
Subjects who received CLs fittings were divided into two major
study groups: those with a refractive factors, including healthy
subjects fitted just to correct their ametropia (myopia, hyperopia, or
regular astigmatism correction), and those where CLs fitting
involve therapeutic factors, including subjects who presented some
type of ocular pathologic condition (e.g., keratoconus, pellucid
marginal degeneration, trauma, or aphakia), secondary irregular
cornea (e.g., after refractive surgery or eye trauma), pediatric
subjects, cosmetic, or prosthetic fitting and subjects who received
treatment to manage myopia (orthokeratology treatment).
The following data were collected for all subjects included in the
study: age, gender, medical history, previous CLs experience,
refraction, best-corrected visual acuity (BCVA) with spectacles and
CLs, manual keratometry readings (OM-4 keratometer; Topcon
Corp., Tokyo, Japan), type of the first diagnostic lens fitted (GP,
hydrogel, or silicone hydrogel), type of the final lens fitted (GP,
hydrogel, or silicone hydrogel), and maximum number of hours of
wearing time for the GP fitting.
The success of the GP fittings was defined as adaptation to
regular, full-time GP wear (at least 6–8 hours of comfortable wear-
ing time) and an optimal physiology of the ocular surface without
CL-related complications (grade .2; Efron Grading Scale6).
Meanwhile, failed GP fittings were determined as unsuccessful
wearers who were unable to reach either a regular daily wear
schedule or who presented subjective discomfort and/or any
CL-related complication.
GP Fitting Procedure
All the GP CLs fit at this clinic were produced in Spain by one of
the three companies: Conoptica-Hecht Contactlinsen, Lenticon,
and Menicon. All lenses fit were an aspheric design and made of
a medium to high Dk material. The fitting procedure for the GP
lenses involved a standardized protocol to achieve a determination
of successful lens parameters and having the subject wear the
lenses (Fig. 1). At the initial visit, demographic information and the
subject history were collected, and a complete eye examination was
conducted to determine whether the subject was a good candidate
for CL wear by assessing ocular and systemic considerations and
the risk of noncompliance by the subject. The subjects who suc-
cessfully passed the initial examination and accepted the use of
CLs after receiving complete information regarding the different
types of CLs and their wearing schedules and replacement frequen-
cies started the diagnostic CL fitting procedure, in which the
FIG. 1. Flow diagram of GP CLs standardized fitting protocol from
the initial eye examination to the successful fitting of the lenses.
practitioner proposed the most adequate lens design and/or material
to meet the needs of the subject. When GP lenses were chosen, the
parameters of the first diagnostic lenses were selected from a trial
set. The first GP diagnostic lens that was calculated was inserted
into the subject’s eye. After an adaptation period of approximately
30 min, the GP lens fitting assessment was evaluated (static and
dynamic fit), and sodium fluorescein was instilled. An acceptable
fit was achieved when a well-centered lens allowed adequate blink-
ing and when a correct fluorescein pattern was obtained, according
to the ISO 11980.2 (Ophthalmic optics, CLs and CL care products,
Guidance for clinical investigation).13 If any parameter of the diag-
nostic lens evaluation was inadequate, the GP was changed, and
a second diagnostic lens was selected. The fitting assessment was
repeated until a correct lens placement was achieved. Once the
parameters for the lens were determined (back optic zone radius
[BOZR] and total diameter), overrefraction was performed to deter-
mine the power of the GP lens and the BCVA, and the GP lens was
ordered from the manufacturer.
The GP lens that was ordered was provided at the second visit
(dispensing visit). The lens fitting, visual acuity, subject comfort,
and the ocular surface were evaluated. If the GP fit was optimal, the
subject was instructed in the management and care of the CLs and
scheduled for a follow-up visit after 2 or 3 weeks of lens wear.
However, if the GP fit was not adequate, the CL specifications
(BOZR, diameter or power) were modified, and a new GP lens was
reordered.
After 2 or 3 weeks of CL wear, a follow-up visit (prescribing
visit) was conducted to assess whether the GP provided at least 6 hr
of regular comfortable wearing time and whether an optimal ocular
surface physiology was maintained without CL-related complica-
tions (grade ,2, Efron Grading Scale). If all these conditions were

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 Eye & Contact Lens
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met, the fit was considered acceptable, the fitting procedure was

concluded and an aftercare plan was scheduled for each subject. If
the GP fit was inadequate or if the subject presented with subjective
discomfort, a new GP was reordered, or the GP fitting was discon-
tinued and another CL material and/or design (soft CL, etc.), de-
pending on the subject’s requirements, was proposed.

Statistical Analysis
Statistical analysis was performed using the SPSS 15.0 (SPSS,
Chicago, IL) statistical package for Windows. A descriptive data
presentation with mean6SD and/or percentages for each studied
variable is provided for both study groups (refractive and therapeu-
tic prescriptions). 95% confidence interval (CI) of percentage of
successful fits was calculated.
Differences from a normal distribution of the variables were
assessed using the Kolmogorov-Smirnov test (P.0.05 indicated
that the data were normally distributed). The effect of a subject’s
previous CL history on GP fitting success was assessed using
a contingency table to compare the type of the first diagnostic lens
with the type of the final prescribed lens. A chi-square test was
used to contrast the frequency of each CL type (GP, silicone hydro-
gels, or conventional soft CLs) to determine diagnostic and final
prescribing lens trends (P,0.05 were considered significant).
Differences in age, refraction (sphere, cylinder, spherical
equivalent), and keratometric readings between successfully and
failed GP subjects with refractive prescriptions were assessed using
nonparametric Mann-Whitney U tests (P,0.05 were considered FIG. 2. Summary of the final prescribed lens type (silicone hydro-
gel, conventional hydrogel, or GP lenses) for those fittings that met
significant). The effect of previous CL experience (neophyte CLs the successful criteria in the refractive group. Differences depending
wearers, previous soft, or previous GP CLs wearers) was also on previous CL wear experience between new CLs wearers, previous
assessed. Percentage of successful and failed GP lens fits between soft CLs wearers, or previous GP CLs wearers are shown. (P,0.01, x2
men and women were compared using a chi-square test (P,0.05 test). The prescribing trend for (A) all refractive fits; (B) new wearers;
were considered significant). (C) previous soft CLs wearers; and (D) previous GP CLs wearers.

This survey revealed prescribing trends for GP lenses in healthy

RESULTS
This retrospective survey included 232 subjects (61.2% women
and 38.8% men) who started a fitting procedure for any type of CL.
Of these fittings, 71.6% were for refractive prescriptions, and
28.4% were for therapeutic prescriptions. The mean age was
33.2612.9 years (range, 1–66 years). Of the included subjects,
34.4% had never worn any type of CL, and 65.6% were previous
CLs wearers (84.1% soft lenses and 15.9% GP lenses).
Refractive Prescriptions (Healthy Subjects)
A total of 166 subjects (68.7% women and 31.3% men) required
a type of CL for refractive reasons. Subjects had a mean age of
32.8612.3 years (range, 11–64 years). The mean spherical equivalent
refractive error was 23.2565.29 D (range, +10.00 to 223.25 D), the
mean flat meridian was 8.7560.29 mm (range, 7.10–8.75 mm), and
mean steep meridian was 7.6060.29 mm (range, 6.70–8.40 mm). In
all, 31.9% of the subjects had never previously worn any type of
CL, and 68.1% were previous CLs wearers (87.6% had used soft
lenses and 12.4% had used GP lenses). Contact lenses were suc-
cessfully fitted for 94.6% (n¼157) of the subjects (mean BOZR
7.7760.27 mm [range, 7.35–8.45 mm] and mean lens diameter of
9.5560.14 mm [range, 9.20–10.00]), and only nine subjects could
not be fitted with any type of CL. Figure 2 summarizes the fitting
trend revealed by these refractive prescriptions and illustrates the
differences regarding previous subject experience in wearing CLs.
subjects, which corresponded to 38.9% of the total fittings con-
ducted during the study period.
Of the 166 subjects analyzed, GP was the first trial lens chosen
option for 88 subjects (53%), followed by silicone hydrogels for 53
subjects (31.9%), and conventional hydrogels for 25 subjects
(15.1%) (P,0.01; chi-square test). Of the 88 subjects who were
initially fitted with GP lenses, 25 subjects (28.4%) had never worn
any type of CL, 50 subjects (56.8%) were previous soft CLs wear-
ers, and 13 subjects (14.8%) were previous GP CLs wearers.
Sixty-one subjects (69.3% successful, 95% CI, 61.6%–75.5%)
of the 88 subjects who were fitted with GP diagnostic lenses were
successful in that they comfortably wore the GP (an average of
7.6161.54 hr per day) and showed an optimal ocular surface phys-
iology. Of the remaining 27 subjects, 4 (4.6% of the refractive
group) were finally fit with silicone hydrogels, 14 (15.9%) with
hydrogels, and 9 (10.2% of refractive group) were unsuccessful in
all CL types. Most of these (six subjects) were previous soft CLs
wearers. When this refractive group was separated according to
previous CL experience, a different percentage in successful fits
were found between neophyte CL wearers (72% successful, 95%
CI, 58.4%–83.8%), previous soft CLs wearers (62% successful,
95% CI, 52.3%–71.7%), and previous GP wearers (92.3% success-
ful, 95% CI, 78.9%–100%) (Table 1).
Sex, age, refraction (sphere, cylinder, and spherical equivalent),
keratometry readings, and BCVA spectacles were compared

Ó 2016 Contact Lens Association of Ophthalmologists 3

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 S. Ortiz-Toquero et al. Eye & Contact Lens
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TABLE 1. Contingency Table Describing the Initial Proposal and the Final CL Fitted
Final Lens Prescribed

Conventional Hydrogel, % (n) Silicone Hydrogel, % (n) GP Lens, % (n) No CL, % (n)

Refractive prescription (healthy eyes) (n¼166)

Type of initial diagnostic lens
Conventional hydrogel (n¼25) 100 (25) 0 0 0
Silicone hydrogel (n¼53) 1.9 (1) 98.1 (52) 0 0
GP lens (n¼88) 4.6 (4) 15.9 (14) 69.3 (61) 10.2 (9)
No previous CL wear (53)
Type of initial diagnostic lens
Conventional hydrogel (n¼12) 100 (12) 0 0 0
Silicone hydrogel (n¼16) 0 100 (16) 0 0
GP lens (n¼25) 0 20 (5) 72 (18) 8 (2)
Previous soft CL wear (99)
Type of initial diagnostic lens
Conventional hydrogel (n¼12) 100 (12) 0 0 0
Silicone hydrogel (n¼37) 2.7 (1) 97.3 (36) 0 0
GP lens (n¼50) 8 (4) 18 (9) 62 (31) 12 (6)
Previous GP CL wear (14)
Type of initial diagnostic lens
Conventional hydrogel (n¼1) 100 (1) 0 0 0
Silicone hydrogel (0) 0 0 0 0
GP lens (13) 0 0 92.3 (12) 7.7 (1)

Data are presented for the refractive group as a whole and are then divided into subgroups according to previous CL experience (neophyte
CL wearers, n¼53; previous soft CL wearers, n¼99; and previous GP CL wear, n¼14).
CL, contact lens; GP, gas permeable.

between successful and failed GP fittings (Table 2). The subgroup
with previous soft CLs experience showed statistically significant
differences (P,0.05) between successful and failed fitting for age,
sphere, and BCVA. However, no statistically significant differen-
ces were found in subjects who had never worn any type of CL.
Therapeutic Prescriptions
A total of 66 subjects (42.4% women and 57.6% men) were fitted
with any type of CL for therapeutic reasons (63.6% for irregular
cornea, 56.1% for keratoconus, 4.5% after refractive surgery or
keratoplasty, and 3% for other conditions, such as eye trauma, and
28.8% for orthokeratology, 4.6% for pediatric cases, and 3% for
cosmetics-prosthetic reasons), with a mean age of 34.1614.4 years
(range, 1–66 years). The mean spherical equivalent refractive error
was 23.2863.93 D (range, +3.75 to 217.50 D), the mean flat
meridian was 7.5560.65 (range, 5.50–9.10 mm), and the mean steep
meridian was 7.1360.65 (range, 5.50–9.10 mm). Of these subjects,
41% had never previously worn any type of CL, and 59% were
previous CLs wearers (73% had worn soft lenses, and 27% had
worn GP lenses). Only five subjects (7.6%) were fitted with thera-
peutic soft CLs (for pediatric and cosmetics-prosthetic indications).
Gas permeable lens was the first trial lens option that was chosen
in 61 cases (92.4%, 95% CI, 93.4%–99.9%); 42 of these had an
irregular cornea and 19 were fit for orthokeratology. Fifty-nine
subjects (96.7%) obtained a successful fitting with comfortable
GP wear and optimal ocular surface physiology. Only two subjects
(3%) who displayed irregular cornea (advanced keratoconus stage)
reported significant subjective discomfort with GP lenses and re-
jected their wear.
DISCUSSION
Contact lens prescribing trends are associated with practitioner
misgivings about GP lenses and hence the number of GP fits have
decreased over time, despite the advantages of this type of lens.7,10
They represent approximately 11% of all CLs that have been fit-
ted3,4,9,10 over the world in past 10 years. There is considerable
variance across nations, ranging from 0.2% in Lithuania to 37%
in Malaysia.3 In the United States, only 9.4% of total fittings are
performed with GP lenses,14 and in Europe, the countries with the
highest number of GP fittings are Germany and the Netherlands
(approximately 30%), whereas Spain and the United Kingdom
present trends for GP fittings similar to those seen worldwide
(approximately 10%).3 Taking into account only refractive pre-
scriptions, the trend for GP fittings that was found in our study
(38.9%) is considerably greater than the current trend in Spain and
in the rest of the world when therapeutic prescriptions are included
in the results. This trend could be related to the academic status of
the IOBA Eye Institute (a university center focused in vision sci-
ences teaching and research).
In many practices, GP lenses have a limited role in refractive
fittings, and this type of lens is not considered the first choice
option3,10,14 in healthy patients for correcting refractive errors. In
2010, Cardiff University10 analyzed the effect of practitioner atti-
tudes on GP lens prescribing in the United Kingdom and found that
the practitioners know the benefits provided by GP lenses pertain-
ing to ocular health and refractive correction. However, this report
concluded that initial patient discomfort negatively influenced
practitioner attitudes because the patients prefer the initial comfort
benefit provided by soft lenses. This consequently results in
reduced GP prescribing.10 Nevertheless, there is no previous evi-
dence regarding the percentage of successful GP CLs fits to support
this professional practitioner behavior. For this reason, we studied
the percentage of successful GP CLs fits in refractive (healthy
subjects) and therapeutic prescriptions, because to our knowledge,
no studies have analyzed this issue to improve the objective infor-
mation that is provided to patients regarding the GP fitting process
and to assist eye care practitioners in their CL clinical activities.
Previous studies have attempted to analyze the factors that can
influence the success of GP fittings.4,5,15,16 Regarding the time

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TABLE 2. Comparison Between Successful and Failed GP Fittings in the Refractive Group
Total GP Trial Lens Fit Successful GP Wear Failed GP Wear P

Sex, n (men/women)
All wearers 88 (27%/73%) 61 (28%/72%) 27 (26%/74%) ,0.01a
New wearers 25 (32%/68%) 18 (33%/67%) 7 (29%/71%) 0.20a
Previous soft CL wearers 50 (26%/74%) 31 (26%/74%) 19 (26%/74%) ,0.01a
Previous GP CL wearers 13 (23%/77%) 12 (25%/75%) 1 (0%/100%) —
Age, mean 6 SD (range), years
All wearers 33.20612.51 (11 to 64) 31.91613.15 (11 to 64) 36.02610.60 (14 to 60) 0.07
New wearers 23.18611.14 (11 to 46) 21.89611.29 (11 to 46) 26.20610.53 (14 to 41) 0.24
Previous soft CL wearers 35.57610.38 (14 to 60) 33.27611.00 (14 to 50) 39.3268.08 (23 to 60) 0.02
Previous GP CL wearers 43.4869.86 (29 to 64) 43.14610.27 (29 to 64) 47.0060.00 (47) 0.51
Sphere, mean 6 SD (range), D
All wearers 24.3766.43 (223.25 to +10.00) 24.9267.14 (223.25 to +10.00) 23.1964.32 (219.00 to +0.50) 0.04
New wearers 22.0664.92 (217.25 to +7.75) 22.2165.56 (217.25 to +7.75) 21.7363.20 (27.00 to +4.25) 0.75
Previous soft CL wearers 25.1166.44 (223.25 to +10.00) 26.1767.24 (223.25 to +10.00) 23.3664.40 (219.00 to +5.50) ,0.01
Previous GP CL wearers 26.9167.54 (222.00 to +7.00) 26.5467.80 (222.00 to +7.00) 210.8760.17 (210.75 to 211.0) 0.20
Cylinder, mean 6 SD (range), D
All wearers 21.5261.04 (20.25 to 25.00) 21.5561.04 (20.50 to 24.25) 21.4561.07 (20.25 to 25.00) 0.60
New wearers 21.3961.04 (20.50 to 24.25) 21.3360.99 (20.50 to 24.25) 21.5661.14 (20.75 to 23.75) 0.58
Previous soft CL wearers 21.6361.11 (20.25 to 25.00) 21.7761.12 (20.50 to 24.00) 21.3961.09 (20.25 to 25.00) 0.15
Previous GP CL wearers 21.4560.82 (20.50 to 24.25) 21.4260.84 (20.50 to 23.00) 21.7560.00 (21.75) 0.72
Spherical equivalent, mean 6 SD (range), D
All wearers 23.8565.55 (223.50 to +7.25) 23.3565.55 (223.50 to +7.25) 24.9265.46 (220.75 to +4.00) 0.05
New wearers 22.5464.93 (217.75 to +7.25) 22.7166.40 (217.75 to +7.25) 24.9364.75 (27.25 to +2.25) 0.24
Previous soft CL wearers 23.8065.03 (220.75 to +5.50) 23.3064.51 (215.75 to +5.50) 24.6065.73 (220.75 to +4.00) 0.19
Previous GP CL wearers 25.1166.86 (223.50 to +5.25) 24.5866.94 (223.50 to +5.25) 210.7561.76 (29.50 to 212.00) 0.07
Keratometry, steep meridian, mean 6 SD
(range), mm
All wearers 7.5560.27 (7.10 to 8.20) 7.5360.25 (7.10 to 8.20) 7.5860.32 (7.20 to 8.05) 0.12
New wearers 7.6160.29 (7.10 to 8.15) 7.5860.31 (7.10 to 8.15) 7.6660.22 (7.15 to 7.97) 0.38
Previous soft CL wearers 7.5160.28 (7.10 to 8.20) 7.5060.23 (7.10 to 8.20) 7.5460.34 (7.20 to 8.05) 0.36
Previous GP CL wearers 7.5660.19 (7.11 to 7.97) 7.5160.15 (7.11 to 7.70) 7.9560.04 (7.92 to 7.97) 0.01
Keratometry, flat meridian, mean6SD
(range), mm
All wearers 7.7560.27 (7.10 to 8.50) 7.7360.26 (7.20 to 8.50) 7.8060.29 (7.10 to 8.35) 0.09
New wearers 7.8360.28 (7.25 to 8.40) 7.7860.30 (7.25 to 8.40) 7.9560.19 (7.75 to 8.35) 0.05
Previous soft CL wearers 7.7060.27 (7.10 to 8.50) 7.6860.24 (7.20 to 8.50) 7.7360.31 (7.10 to 8.23) 0.53
Previous GP CL wearers 7.7760.22 (7.30 to 8.10) 7.7860.30 (7.25 to 8.40) 8.0460.02 (8.03 to 8.06) 0.04
BCVA with spectacles
All wearers 0.9360.30 (0.05 to 1.50) 0.8560.32 (0.05 to 1.50) 1.0660.21 (0.50 to 1.50) ,0.01
New wearers 1.0060.22 (0.10 to 1.50) 0.9960.27 (0.10 to 1.50) 1.0460.08 (1.00 to 1.20) 0.83
Previous soft CL wearers 0.9360.31 (0.10 to 1.50) 0.8460.31 (0.10 to 1.50) 1.0760.24 (0.50 to 1.50) ,0.01
Previous GP CL wearers 0.7560.36 (0.05 to 1.20) 0.7360.40 (0.05 to 1.20) 0.9060.00 (0.90) 0.95

Factors included are the following: sex distribution, age, refraction (sphere, cylinder, and spherical equivalent), keratometry (steep and flat
meridian) and BCVA obtained with spectacles. Details of the comparisons for the previous CL experienced groups are also summarized.
a
Chi-square test (gender distribution difference).
BCVA, best-corrected visual acuity; CL, contact lens; GP, gas permeable.

required for successful wearers to adapt to GP lenses, Fujita el al.16
established an average time of 23.0622.1 days. Carracedo et al.4
reported that unsuccessful GP wearers presented an overall trend
for having more unstable levels of tear film and an increasing
intensity of symptoms during the first 7 days, including dryness,
discomfort, foreign body sensation, sand sensation, and irritation.
However, successful GP wearers showed a steep trend toward
increasing comfort and wearing time during the first 7 to 15 days.
Our fitting protocol required a minimum of 2 or 3 weeks of GP CLs
wear to evaluate a patient’s comfort to be considered successful, in
accordance with these previous reports.
Polse et al.5 prospectively analyzed 411 GP fittings and concluded
that younger patients, inexperienced patients with a steeper corneal
curvature and a lower rate of predicted residual astigmatism had
a higher probability of achieving successful GP wear. However,
our results disagree with the conclusions of Polse et al because we
did not find statistical differences in new CLs wearers in any of the
clinical data proposed by Polse to calculate the probability of suc-
cessful of GP wear (Table 2), suggesting that is not possible to make
an accurate prediction of successful GP wear in neophytes. However,
taking into account the previous CL experience of the subject, slight
differences in the successful GP wear between neophyte (72%),
previous soft (62%), and previous GP (92.3%) CLs wearers were
found (Table 1). This could mean that previous soft CLs wear is an
important factor that contributes to unsuccessful GP wear because
these wearers could be accustomed to the initial comfort provided by
soft lenses, and the initial discomfort produced by GP lens could be
greater and unacceptable in these subjects. Moreover, in previous
soft CLs wearers, statistical differences (P,0.05) in age, sphere, and
BCVA with spectacles were found between subjects that achieved
successful or unsuccessful GP lens wear (Table 2). These results
suggest that younger people with a higher refractive error and a lower
BCVA with spectacles are more likely to be successful when refit
with GP lenses.
Moreover, Polse et al.5 found a 69.6% percentage of successful
GP fits when prescribing a spherical lens design in 1999. Nearly two
decades later, even with advances in manufacturing technology that
have permitted the development of new GP lenses with aspherical

Ó 2016 Contact Lens Association of Ophthalmologists 5

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 S. Ortiz-Toquero et al.
designs and high oxygen permeability materials, the percentage of
successful GP CLs fits remains similar (69.3% in our study). This
result suggests that successful GP wear may highly depend on a pa-
tient’s attitude and depend less on the relative impact of lens design,
material, and so on, in agreement with the recommendations of
Bennett et al.,15 which highlighted that an important factor that con-
tributes to achieving a successful GP fit is the method by which GP
lenses are presented and the information is provided to a patient.
Bennett et al.15 concluded in their study that information for all
types of CLs should be provided to a patient, including the positive
and negative factors related to each option, and that in the case of GP
lenses, if the practitioners present these lenses with a positive but
realistic attitude, explaining the benefits and the initial awareness that
are produced, then subjects are more likely to succeed in GP wear
during the initial critical period. Our study results provide evidence-
based results that can improve the information provided to subjects
and assist them when they choose a type of CL in clinical practice
because almost 7 of 10 subjects (69.3%) who start a GP lens fitting
process to correct a refractive error (refractive prescription) achieve
regular and comfortable GP lens wear times (Table 1).
However, for therapeutic prescriptions for subjects with kerato-
conus, pellucid marginal degeneration, corneal distortion or
irregularity, or have undergone refractive surgery or orthokeratol-
ogy treatment, the percentage of successful GP fits (96.7%) is
considerably greater than in subjects with healthy eyes (69.3%).
This difference in percentage of successful fits between refractive
prescriptions and therapeutic prescriptions could be related to the
great improvement obtained in BCVA when GP lenses are used in
patients with irregular cornea,17 which can have a great impact on
a patient’s quality of life.18 Orthokeratology subjects exhibit a great
attitude when choosing this type of lens and when wearing them
that may help them to accept the initial discomfort of GP lenses,
which could be limited, especially in overnight wear.
This study is not free of limitations. It is a single-center
retrospective study, and a multicenter, prospective, randomized
clinical trial could be necessary to clarify the percentage of
successful GP fits. This could include an assessment of the way
the information is presented to subjects for different types of
available lenses, a description of their advantages and disadvan-
tages, and the risks of CLs wear-related complications associated
with each CL type, and so on. Moreover, such a study could assess
the possible factors that can influence the success of GP lens wear,
including patient preferences and needs. Moreover, it would be of
great interest to monitor these subjects to know whether they wear
GP lenses over time.
CONCLUSIONS
Our study has revealed that following standardized CLs fitting
protocol, including clear and complete information regarding the
6 Eye & Contact Lens
Volume 0, Number 0, Month 2016
Copyright @ Contact Lens Association of Opthalmologists, Inc. Unauthorized reproduction of this article is prohibited.
Eye & Contact Lens
Volume 0, Number 0, Month 2016
advantages and disadvantages of the different CLs types, a rela-
tively high percentage of successful GP fits could be achieved in
refractive prescriptions. In therapeutic prescriptions, the percentage
of successful GP fits was higher. These results improve the
information that can be provided to subjects at the beginning of
the CL fitting process, which can help subjects to choose a lens
type (by providing a them with positive and realistic attitude) and
help eye care practitioners in their CL clinical activities (by
providing evidence-based information).
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